Deep brain stimulation effective, safe for treatment-refractory OCD

Deep brain stimulation of the ventral anterior limb of the internal capsule, or vALIC, in a regular clinical setting is effective and safe for treating treatment-refractory OCD, according to results of a clinical cohort study published in American Journal of Psychiatry.

“Despite the efficacy and tolerability of [deep brain stimulation] and its potential to improve the lives of many patients with refractory OCD, evidence for the effectiveness of [deep brain stimulation] in OCD remains limited,” Damiaan Denys, MD, PhD, of the department of psychiatry at University of Amsterdam, and colleagues wrote. “Few studies examining the efficacy of [deep brain stimulation] for OCD have been published, and the total number of OCD patients treated with [deep brain stimulation] worldwide probably does not exceed 250.”

According to the researchers, deep brain stimulation in patients with OCD is often targeted to several brain regions, including the vALIC, ventral striatum, subthalamic nucleus and nucleus accumbens. They included data from 70 consecutive patients, as well as 16 from a previous trial, who received bilateral deep brain stimulation of the vALIC and were followed for 12 months at a time point between April 2005 and October 2016. They assessed primary effectiveness according to the change in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) from baseline until the 12-month follow-up. Denys and colleagues defined response as a 35% or greater decrease in Y-BOCS score, partial response as a 25% to 34% decrease and nonresponse as a 25% or lower decrease. They used Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D) as secondary effectiveness measures.

The researchers reported that Y-BOCS, HAM-A and HAM-D scores decreased significantly during the first 12 months of deep brain stimulation, for a mean Y-BOCS score decrease of 13.5 points (40% reduction), mean HAM-A score decrease of 13.5 points (55% reduction) and HAM-D score decrease of 11.2 points (54% reduction). At the 12-month follow-up, 52% of the 70 patients were categorized as responders, 17% as partial responders and31% as nonresponders. The researchers noted transient symptoms of hypomania, agitation, impulsivity and sleeping disorders as adverse events.

“Future studies could focus on specific elements of this approach to examine how each phase affects [deep brain stimulation] outcome,” they wrote. “Investigating predictors of success could improve [deep brain stimulation] selection, and examining the effects of [cognitive behavioral therapy] may distinguish between the effects of modulation and consolidation.” – by Joe Gramigna

Disclosures: Denys reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.